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Troy Polamalu, right, will miss Sunday's game due to a leg injury suffered Oct. 7 against the Eagles.

Coach Mike Tomlin called football a "game of attrition" when the Steelers hired him, and they are discovering just what that can mean.

Injuries have piled on like a scrum for a loose football, and, for a brief moment Thursday, it appeared the Big One might have hit.

Quarterback Ben Roethlisberger tripped while dropping back to pass in practice and injured his right foot. It's the same foot that was broken two years ago.

After being examined inside, Roethlisberger returned to the locker room, looked at his bare foot and pronounced it "fine."

Many of his teammates are not.

Starters Troy Polamalu and Marcus Gilbert won't play Sunday night in Cincinnati, the fourth game that Polamalu will miss. Their top two running backs, Rashard Mendenhall and Isaac Redman, both could miss it as well. Mendenhall did not play in the first three games. Pro Bowl center Maurkice Pouncey finally went through a limited practice Thursday, but his appearance is in doubt for Sunday.

Before the regular season began, they lost two other starters, rookie offensive guard David DeCastro and fullback David Johnson, to injuries, along with promising rookie linebacker Sean Spence. Only DeCastro might be back in the second half of the season.

They also lost James Harrison for the first three games. LaMarr Woodley will start Sunday after missing the past seven quarters.

It's tough enough for teams to win in the NFL on talent alone; they need some help by staying healthy, and the Steelers just have not been a healthy team.

Polamalu said it's like déjà vu.

"Sometimes, I wonder if it's just us here because it seems as if we deal with it pretty seriously every year. I obviously am aware of Baltimore's situation, but it seems like we face those type of situations year in and year out."

The Ravens looked as if they might run away with the AFC North Division title with a 5-1 start as the Steelers (2-3) and the Bengals (3-3) floundered. Then Baltimore was hit by a twin bolt last week when it was revealed the heart and soul of their defense, linebacker Ray Lewis, might miss the rest of the season with a torn biceps, and Lardarius Webb, their best cornerback, was lost for 2012 with a torn ACL.

The Ravens also have played six games without perhaps their best defensive player, linebacker Terrell Suggs, who might return Sunday to play in Houston. Pro Bowl safety Ed Reed continues to play with what he said is a torn labrum.

"Everybody is going through it," said offensive guard Willie Colon, who played in just one game over the two previous seasons because of injuries. "They weren't worried about it when Troy went down and they weren't worried about it when James went down, so I don't think we have time to worry about them."

The Bengals are healthy today after going through a bloody beginning.

"It's about as good as it's been," Cincinnati coach Marvin Lewis said of his team's health. "We kind of turned the corner after our third or fourth game, so we've got some guys back. Unfortunately, the guys we've lost, we lost for the year."

Starting outside linebacker Thomas Howard played in the opener, then was lost for the season with a torn ACL sustained in practice. They lost two starting offensive linemen in the preseason, center Kyle Cook and guard Travelle Wharton.

Injuries, goes the cliché, are a big part of football, but sometimes they can be the biggest part. The 2011 Indianapolis Colts went from possible Super Bowl contenders to 2-14 without injured quarterback Peyton Manning.

"I'm sure it plays a huge role," Polamalu said of how injuries affect a team's prospects.

"It's all common-sense situations," Colon said.

"If Troy's healthy, if [Harrison's] healthy, if [Woodley's] healthy, obviously it gives us a lot of chances to win. But I think it's the team with the best depth -- when guys go down can your backup be just as good as your starter or even better? Those are the teams that make it."

The Steelers in the past have had such teams. Now their current depth is being tested.

Ryan Mundy started the first three games filling in at both safeties because of injuries. The coaches apparently were not happy enough with his play because they started Will Allen instead for Polamalu in Tennessee.

Rookie Mike Adams will make his first NFL start Sunday in Gilbert's spot at offensive right tackle. Jonathan Dwyer might have to make his first start at halfback.

"This is where depth is important in football," said Byron Leftwich, who would start at quarterback if something were to happen to Roethlisberger.

"You have a starter at a consistent certain level, and you may have a good backup at that position who may play at a consistent level. But, when you have a starter down, now you're asking a backup to play at the same consistent level as the starter, and now you're asking the backup to the backup to play at the same consistent level as the backup played.

"That's the thing when you start losing people, you hope you're deep enough to be able to fill in the void."

Dwyer might get first start

If neither Mendenhall nor Redman practice today, Dwyer said he will look forward to starting against the Bengals.

"For every running back, their first start is always something special," Dwyer said. "I'll just be excited to get out there playing again."

Dwyer has not pulled on a uniform the past two games after Mendenhall returned from his ACL injury. He was the odd back out because they had their top two backs, their third-down back in Baron Batch and their wild-card scatback, Chris Rainey.

"The way it all happened, it made it look like I wasn't playing because I fumbled and things like that," Dwyer said. "It was all a numbers game."

Dwyer lost a fumble at the Steelers' 31 in the third game, the Oakland Raiders recovered and polished off a short drive with a touchdown to tie the score, 14-14, late in the second quarter.

Bengals seek killer instinct

Sunday night football in Cincinnati between two division rivals always has a chance for some fierce play. After Lewis called out his team for playing "too nice," he might have thrown some kerosene on it.

"We need to develop a killer instinct," Lewis explained. "We need to play for four quarters, to win every down and not relax. Don't drop the standard. That's really important. That's what any great team in the National Football League has. You have to have a killer instinct.

"You have to win down after down after down. You don't get ahead and relax. You just have to keep playing hard every single play and win every single down. Don't let your man make the tackle. You defend your gap and, when the ball is in my gap, I make the tackle. I cover my man. I just do my thing. That's what it is."

Timmons has a full practice

Some good injury news for the Steelers: Lawrence Timmons, who skipped practice Wednesday with a foot injury, returned to a full practice.